1Senior Associate Faculty, Rollins School of Public
Health, Emory University, Atlanta, GA; 2Professor,
Rollins School of Public Health, Emory University; 3Professor, College of Nursing, University
of Utah, Salt Lake City; 4Project
Director, Rollins School of Public Health, Emory University

The purpose of this study was to identify
HIV prevention goals of college students, to determine if there are
differences in goal setting between males and females, and to determine
if an association exists between goal setting and behavior. The data
are from a study designed to identify HIV prevention practices of college
students. The results of the study showed that 71.4% of the respondents
indicated that they had a goal to reduce their risk of contracting HIV.
The primary goals identified were condom use, limiting number of partners,
abstinence, and monogamy. Females were more likely to select abstinence
as their first goal, and men, condom use. Females were more likely than
males to write high specificity and definitely effective goals. Significant
associations were also found between HIV prevention goals and sexual
behaviors. When males and females stated abstinence as their goal, there
was a significant association with reports of never having sex. This
association was significant for both sexually experienced males and
females when the goal of abstinence was compared with the occasions
of sex in the last three months. For males, having a condom use goal
was significantly associated with consistent condom use. However, no
significant association was found between females’ condom use goals
and reported consistency of condom use.

Key words: HIV/AIDS, college students, goal-setting, sexual behavior

Introduction

Estimates
based on the age distribution of AIDS cases suggest that about half
of new HIV infections are among people under the age of 25,1
and the majority of these infections are acquired through sexual behaviors.2
These statistics hold particular relevance for undergraduate college
students most of whom are under 25 years of age and many of whom practice
sexual behaviors that place them at risk for contracting HIV. In order
to avoid HIV infection, college students, like others, must adopt behaviors
to protect themselves. To date, the study of prevention behaviors among
college students has focused on identifying antecedents to risk reduction
behaviors including knowledge, attitudes toward condom use, and confidence
in using a condom and discussing condom use with a sexual partner.3-5This
research has yielded important results that have been incorporated into
risk reduction education programs. A much less studied area, but one
that is important to self-regulatory behavior, is that of goal setting.

According to Bandura, a personal
goal is something a person wants to accomplish.6
He notes that goals are important in the self-regulation of behavior
because they help focus attention on the desired behavior, increase
efforts toward the attainment of the desired behavior, and enhance persistence
in the face of difficulties. Moreover, goal statements work to create
internal standards against which current behavior can be compared. When
behavior deviates from these predetermined standards, internal incentives
can be created to modify behavior to meet desired performance goals.

The nature of goals and the association between goal
setting and task performance has been examined in a number of studies.7-11
Investigators have found that goal statements can vary in their level
of specificity, the level of difficulty, and the proximity to desired
outcomes.6
Overall people who set goals for the purpose of meeting some performance
standard are more likely to be successful than those who do not set
goals, but have the same desired outcome.6
Moreover, successful outcomes are more likely for people who set more
specific or challenging goals.10
Although research addressing health related goals is minimal, investigators
have shown the success of goal setting within the health domains of
weight training,8
smoking cessation,7
and endurance performance.9
For example, Boyce and Wayda8
found among female university students engaged in a weight training
experiment, the performance of those who had set their own goals (self‑set
goals) or who were assigned goals was significantly better than that
of women in the control group who had no goals.

Although there is little empirical
data supporting the relationship between goal setting and HIV risk reduction
behaviors, interventionists often incorporate goal setting into prevention
education.12,13
For example, a successful cognitive-behavioral risk-reduction intervention
among adult men and women included goal setting as a technique to enhance
perceived self-efficacy.13
However, in this study, the role of goal setting in changing behavior
was not disentangled from that of the other mediators of change including
self-efficacy and outcome expectancies. Because research in health behavior
suggests that setting goals acts as motivation for behavioral change7-9and
goal setting is already included in many HIV prevention programs,12,13
the study of self-set goals and their relationship to the adoption of
risk reduction behaviors is timely. To expand the understanding of risk
reduction goals, the first aim of this paper was to determine the types
of HIV prevention goals set by college students. Because men and women
report differences in the adoption of HIV prevention behaviors, the
second aim was to determine if gender differences exist in HIV prevention
goals, and the third aim was to explore the association between goal
setting and behavior.

Methods

Procedures

Data for this study were collected as part of a larger
study on HIV risk-reduction practices of college students. Participants
were selected from students attending six colleges and universities,
both public and private, in a large southeastern metropolitan area.
Once approval had been obtained from the institutional review board
at each school, a request for a random sample of students currently
enrolled in a degree-seeking program and under age 25 was made to each
registrar. The address lists were checked for completeness; those students
without a complete address were deleted from the sample. Survey packets
that included the study questionnaire, a cover letter containing the
elements of informed consent, a self-addressed, stamped envelope, and
a five-dollar bill as an incentive to complete the survey were sent
to students. Students were asked to complete the questionnaire and return
it. Survey packets were sent by first class mail; a reminder postcard
was sent one week after the first mailing, and a second survey packet
was sent to the non-responders three weeks after the first mailing.
Of 5,893 survey packets mailed, 2,468 were returned representing a 42.9%
response rate.

Sample

The sample was limited to respondents
who were unmarried, between 18 and 25 years of age who had written at
least one HIV prevention goal (N = 1,525). The average age of
the sample was 20.2 years (SD = 1.73). Fifty-four percent of
the total sample was female, 31.7% was white, 58.8% African American,
4.9% Asian, 3.6% Hispanic, and 1% Native American or other. Twenty-nine
percent of the participants were freshman, 22.2% sophomores, 24% juniors,
and 24.6% seniors. Ninety-six percent of the sample identified themselves
as heterosexual, 1.8% identified as bisexual, and 1.3% as homosexual,
with .5% not responding. Eighty-six percent of the males and 87% of
the females were sexually active. Sexually active was defined as ever
having had vaginal, oral or anal sex. For the males in the sample, 18.2%
reported no occasions of vaginal, oral or anal sex in the past 3 months;
16.2% of the females reported the same.

Measures

To measure HIV prevention goals,
participants indicated whether they had personal goals by responding
to the question, “Do you have any personal goals at this time about
reducing your risk of being infected with HIV? By personal goals, we
mean have you made up your mind to make some change, or to maintain
some change that you have previously made in your sexual relationships,
your use of drugs, or any other aspect of your life that might place
you at risk for HIV?” They were then asked, “If yes, what is your personal
goal or goals (i.e., what have you made up your mind to do)? Please
be as specific as possible. List each goal separately if you
have more than one goal.” Participants were not asked to rank their
goals in order of importance.

Each goal was evaluated and coded
on four dimensions—content, specificity, effectiveness, and control.
These four dimensions were agreed upon and a goal coding manual was
developed to guide the coding of goals. Goal content refers to the subject
matter of the goal. Based on goal statements, 14 content categories
were identified. The categories were the following:

condom use

protection/safer sex

discussion/communication

education

limit number of partners

monogamy

marriage

abstinence

no drugs/alcohol

no IV drugs

no anal sex

testing

avoiding “tempting” situations and
being prepared

other

If a goal did not fit into any of
the first 13 categories, it was coded as “other.” Specificity refers
to the extent to which specific actions and/or timeframes are included
in the goal statement. The specificity dimension was rated as one of
three categories: high (e.g., always use a condom), medium (e.g., use
condoms), or low (e.g., use condoms more). Effectiveness refers to the
probable efficacy of the goal. The effectiveness dimension was rated
as one of four possible categories: definitely effective (e.g., use
a condom each and every time), possibly effective (e.g., use condoms),
indirectly effective (e.g., getting tested for HIV), and ineffective
(e.g., use the pill).

Control refers to the locus of control
for the successful completion of the goal. The control dimension was
divided into three categories: self-control (e.g., abstinence), mutual
control (e.g., condom use), or other control behavior (e.g., have my
partner tested). Before coding the entire data set, raters were trained
on using the coding manual. The percent agreement between the trainer
and the raters was assessed for each dimension and was required to be
.90 or above before coding began.

Sexual activity status was determined
by asking 3 questions: “How old were you when you first willingly
had vaginal intercourse/oral (oral-genital contact) intercourse/anal
intercourse?” For each question the respondent could provide an age
or check “never had.” For this study, a dichotomous measure was used
where 0 represented those who had never engaged in any sexual activity
including vaginal, oral or anal sex, and 1 represented those who had
engaged in at least 1 of the 3 behaviors.

Sexual
activity in the past three months was assessed by asking, “ With how
many different partners have you had sexual intercourse in the past
3 months?” For this analysis, the results were dichotomized into those
who had no partners in the past three months and those who had one or
more.

Condom use was measured using responses to
the item, "How often do you use a condom?" The item was rated
on a 5‑point scale ranging from never to every time. For this
analysis, this measure was dichotomized into consistent condom users
(every time or almost every time) and inconsistent users (sometimes
to never).

Results

Data were analyzed using SPSS 9.0.
Descriptive statistics were used to identify the types of HIV prevention
goals for males and females, and chi square analyses were used to assess
differences in the dimensions of goal statements for males and females
and to examine the association between goal setting and behavior. The
large sample size (n = 1, 525) provides considerable statistical
power to detect small differences as statistically significant. To aid
in the interpretation of the chi square statistics, we have included
Cohen’s (1988) measure of effect size, w, which in all tables
reported here is equal to (also equal to phi and Cramer’s V in the tables).
We have only included w for chi squared values associated with
p < .001. Cohen14
has proposed small, moderate, and large effect size of w = .1,
.3, and .5 respectively.

For
the analyses, only the first goal written by each respondent was evaluated
because by using only the first goal all participants who had goals
were included. The top four responses written for the HIV prevention
goals were: 23% condom use, 22% limiting number of partners, 19% abstinence,
and 17% monogamy. Forty percent of participants identified a high specificity
goal, 35% a medium specificity goal, and 25% a low specificity HIV prevention
goal. Forty-five percent of all participants identified a possibly effective
HIV prevention goal, 33% a definitely effective HIV prevention goal,
22% an indirectly effective HIV prevention goal, and less than one percent
an ineffective HIV prevention goal. Fifty-seven percent of participants
identified a self-control goal, 42% a mutual control goal, and less
than one percent another control goal.

With
respect to the types of goals males and females wrote, a significant
association was found between gender and the content dimension of participants’
HIV prevention goals (χ2 (13, 1,525) = 34.63, p
< .001) (Table 1). Males were significantly more likely to state
a condom use goal (χ2 (1, 1,525) = 4.27, p <
.05) and a no IV drug use goal (χ2 (1, 1,525) = 5.62,
p < .01). Females were more likely to state an abstinence
goal (χ2 (1, 1,525) = 8.67, p < .01).

With regard to the other three dimensions
(specificity, effectiveness, control), a significant association was
found between gender and the specificity dimension of participants’
HIV prevention goals (χ2 (2, 1,525) = 19.04, p
< .0001). Females were significantly more likely than males to write
a goal that was coded as high specificity, and males were significantly
more likely than females to write a goal that was coded as low specificity.
A significant difference was also found between males and females in
the effectiveness dimension for the goals (χ2 (3, 1,525)
= 9.25, p < .026). Females were found to be more likely to
write a definitely effective goal (Table 2). No significant gender differences
were found for the control dimension.

In the last stage of analysis, the
association between the participants’ goals and their self-reported
behavior was explored. The association between abstinence and condom
use goals and self-reported measures of sexual activity and condom use
were assessed. In the overall sample, those who defined abstinence as
their goal were significantly more likely to never have engaged in sexual
intercourse (vaginal, oral or anal) (χ2 (1, 1,525) =
290.79, p < .001) (Table 3). Additionally, those who were
sexually experienced and who defined abstinence as their goal were more
likely to have not engaged in sex in the past 3 months (χ2
(1, 1,328) = 80.581, p <.001). Participants who had condom
use as their goal were more likely to report consistent condom use (χ2
(1, 1,266) = 6.32, p <.05).

Table 3. Association between HIV
prevention goals and behavior

Abstinence goal

Yes

No

Ever engaged in sexual activity**

%

n

%

n

χ2

Yes

54.4

163

94.0

1162

290.792a

No

43.6

126

6.0

74

Sexual activity in last 3 months**

Yes

54.3

89

84.0

978

80.581b

No

45.7

75

16.0

186

Condom use goal

Yes

No

Condom use*

%

n

%

n

χ2

Consistent

71.8

227

64.1

609

6.138

Inconsistent

28.2

89

35.9

341

* p < .05; ** p
< .001; aw = .44; bw =
.25

To examine gender differences in
the association between goals and behavior, separate chi square statistics
were run for males and females. When males (χ2 (1, 699)
= 133.01, p <.001) and females (χ2 (1, 862)
= 162.277, p <.001) stated abstinence as their goal, there
was a significant association with reports of never having sex (Table
4). In addition, the association was significant for both sexually experienced
males (χ2 (1, 605) = 32.55, p < .001) and
females (χ2 (1, 723) = 50.85, p <.001) when
the goal of abstinence is compared with the occasions of sex in the
last three months (no sex v. had sex). For males, having a condom use
goal was significantly associated with consistent condom use (χ2
(1, 582) = 8.43, p <.01). However, no significant association
was found between females’ condom use goals and reported consistency
of condom use (χ2 (1, 684) = .36, p = .5393)
(Table 5).

Table 4. Association between HIV
prevention goal and behavior for students who define abstinence as their
first goal

Abstinence goal

Males

Yes

No

χ2

Ever
engaged in sexual activity*

%

n

%

n

Yes

51.8

57

92.9

547

No

48.2

53

7.1

42

133.007a

Sexual activity in last 3 months*

Yes

50.0

29

82.1

449

No

50.0

29

17.9

98

32.548b

Females

Ever engaged in sexual activity*

Yes

59.2

106

95.1

615

No

40.8

73

4.9

32

162.277c

Sexual activity in last 3 months*

Yes

56.6

60

85.7

529

No

43.4

46

14.3

88

50.851d

* p < .001; aw
= .44; bw = .23; cw = .43;
dw = .26

Table 5. Association between HIV
prevention goal and behavior for students who define condom use as their
first goal

Condom use goal

Yes

No

c2

Males*

%

n

%

n

Consistent condom use

80.8

126

68.5

292

Inconsistent condom use

19.2

30

31.5

134

8.432a

Females

Consistent condom use

63.1

101

60.5

317

Inconsistent condom use

36.9

59

39.5

207

.356

* p < .001;
aw = .12, p = .004.

Discussion

The first aim of this study was to
describe the HIV prevention goals of college students. The results show
that college students’ first priorities to prevent HIV included condom
use, limiting number of partners, abstinence, and monogamy. All of these
goals are effective methods to reduce the likelihood of contracting
HIV. These findings are consistent with the literature that suggests
that college students are knowledgeable about HIV and the actions needed
to prevent contracting the virus.15-18

In regard to the other goal dimensions,
most participants wrote a high or medium specificity goal and identified
either a definitely or possibly effective goal. Moreover, the majority
of participants wrote a goal that was considered to be a self-control
goal (57%) suggesting that participants view HIV prevention as under
their own control. It is encouraging that college students are able
to identify and set goals that are related to effective HIV prevention
practices.

In accordance with Eagly’s social
role theory19
and the literature that suggests that males and females have different
sexual behaviors,3,20
a significant difference was found between the responses
given by males and females on the content dimension of their HIV prevention
goals. When examining participants’ goals, males’ number one goal was
condom use, while females’ number one goal was abstinence. This finding
conforms to the tenets of social role theory in that the assertive qualities
that define the masculine role, as well as society’s acceptance of male
sexuality, may allow a man to seek out and plan for sex, e.g., carry
and use a condom. Within sexual relationships, women have been defined
as the “gatekeepers” with abstinence being a stereotypical behavior
of females.Despite recent changes in attitudes toward women’s sexuality,
it appears that women in this study may still feel reluctant to put
such a sexually assertive goal as condom use as their first priority.
However, women do seem to recognize the importance of condom use as
a protective behavior against HIV transmission. When considering all
goals listed, condom use was the second most frequent goal (36%) written
by women after limiting partners (38%).

Significant gender differences were
also found when other dimensions of the goals were compared. Females
were found to write high specificity goals more often than males. The
initial findings suggested that this difference might be due to the
higher rate of women writing abstinence goals, which usually is coded
as high specificity. To further explore men and women’s differences
in goal specificity, differences within the content areas where men
and women differed, namely condom use and abstinence were examined.
These findings showed that when both males and females wrote condom
use as their HIV prevention goals, there continued to be a significant
difference in the level of specificity. However, upon closer scrutiny
women were writing goals such as “do not have sex, unless a condom is
used,” which added an abstinence dimension to a condom use goal. Women
seemed more likely to have a back-up plan of refusing sex if a condom
was not used, which was reflected in higher specificity scores.

The findings of this study also
demonstrate significant associations between the HIV prevention goals
of condom use, abstinence, and self-reported behaviors. For the overall
sample, a participant who wrote an abstinence goal was significantly
more likely to have never had sex. Because this is cross-sectional data,
the nature of this relationship and whether this goal will predict future
behavior cannot be determined. However, another finding that may lend
some support to the role of goal setting in behavior is that of those
who have been sexually active in the past and have written an abstinence
goal, 46% reported no sex in the past three months, compared to 15.9%
of those who had not written an abstinence goal. This seems to indicate
that those students who have initiated sex and yet wrote an abstinence
goal were consciously restricting their sexual activity up until the
time of this survey. These findings were true for both males and females.

With
respect to condom use overall, participants who wrote condom use goals
were more likely to report being consistent users of condoms. However,
there were gender differences within this association. It seems for
men, having condom use as a goal was significantly related to consistent
condom use, yet for women, having condom use as their goal showed no
association with consistent condom use. One explanation for this finding
may relate to control. Because condom use for women may function more
as an other-controlled goal, rather than a mutually or self-controlled
goal, even though a woman may have condom use as her first priority
she may not be able to enact this goal with a resistant partner. For
men, however, condom use may be more of a self- or mutually-controlled
goal, allowing them more power to ultimately enact the behavior.

Limitations

The response rate of 42.9% indicates
that the majority of students receiving the survey chose not to participate
or for one reason or another did not read the invitation. To investigate
possible selection and response biases, the reported sexual behavior
of the sample (i.e., rates of sexual activity) were compared to other
national samples of college students (the National College Health Risk
Behavior Survey and the National Survey of Family Growth), and found
to be comparable.21,22
Moreover, the rate of condom use in this sample is similar to what is
reported elsewhere in the literature for college students.23,24
The sample characteristics to the enrollment figures of the schools
from which each sample was drawn were also compared; the samples were
similar in age, race, and academic status to those of the populations
at each school. However, each sample had a greater proportion of female
respondents than its respective school population. Thus, these data
have limited generalizability to the school populations and also to
young adult populations that are not attending college. It is also important
to note that because there might be a female bias in the sample, the
comparisons for men and women may not be entirely accurate.

The design and analyses also impose
certain limitations. Cause and effect relationships cannot be inferred
due to the cross-sectional nature of the design. The use of multiple
tests in the analyses (without corrections) increase the possibility
of type I error. To guard against making spurious conclusions, statistics
and significance levels for each finding below .05 were reported allowing
the reader to assess the relative strength of each finding, and only
those findings that were highly significant (<.001) and based on
hypotheses generated from theory were discussed. As is the case for
most research on sexual behavior, the data are all self-report. There
is no objective measure of the participants’ sexual and condom use behavior
and no way to verify the accuracy of their reports. In addition to the
limitation inherent in multiple tests, another limitation is that with
such a large sample, we have been able to detect small differences as
statistically significant. The reader should be aware that for the findings
discussed above, effect sizes ranged from small to moderate.14The largest effect size of w = .44 was seen in associations
between abstinence goals and sexual activity.

Implications for practice and research

Despite the limitations of the study,
the findings point to several implications for health education practice
and research on college campuses. First, although the goals written
by participants covered over 14 different content areas, the primary
goals corresponded to effective HIV prevention behaviors commonly recommended
by the Surgeon General and Healthy People 2010 to prevent the contraction
of HIV.25One of the leading health indicators for Healthy People 2010 is
the increase in condom use among sexually active adults. It is good
news that college students seem to be heeding these recommendations.
However, further research needs to be done to determine if written goals
are simply a reflection of knowledge or a real commitment to reduce
risk of contracting HIV. The results of this study show that males and
females differ somewhat in the type of goals they set and the level
of specificity of those goals. While the percent of females who endorsed
the top four goals was similar, males clearly favored condom use over
abstinence. Females also tended to write goals that were more specific
and effective than males.

This study is an initial study describing
self-reported HIV prevention goals and risk-reduction behaviors of college
students.It would be of interest to know if these findings can be replicated
in other samples. Doing so would provide information that could be important
in tailoring HIV prevention goal setting based on gender. In the meantime,
information gained from this study can serve as a foundation for additional
research on risk behaviors among college students and the development
of age-specific interventions.

Finally, based on the results of
the associations between goals and behavior, it appears that the inclusion
of goal setting in HIV prevention programs might be beneficial. Bandura
notes that goals that are more specific and more proximal to the behavior
are more likely to be successfully met than those that are vague or
relate to behavior in the distant future.6
Health educators who include goal setting in their programs may need
to focus on setting goals that are specific to the behavior and developing
the skills necessary to carry out those goals. Future research needs
to consider whether there are age, racial, or gender differences in
the likelihood of individuals to follow through on their defined HIV
prevention goals along with their self-efficacy to act on their goal.
Intervention research could focus on the effects of goal setting so
that its efficacy can be discriminated from other components of the
intervention.

References

1. Rosenberg, P.S., Biggar R.J.,
Goedert J.J. (1996, Mar 17). Declining age at HIV infection in the United
States [letter]. New England Journal of Medicine,330(11),
789-90.

21. Abma,
J.C. (1997). Fertility, family planning, and women's health: New
data from the 1995 National Survey of Family Growth. National Center
for Health Statistics. Vital and Health Statistics Series No. 23, June
18,1997.

25.U.S.
Department of Health and Human Services. Healthy People 2010.
2nd ed. With Understanding and Improving Health and Objectives for Improving
Health. 2 vols. Washington, DC: U.S. Government Printing Office, November
2000.

Acknowledgement:

This study was funded by a grant from the National
Institute of Nursing Research No. 1 R01 NR03124

Copyright, Southern
Nursing Research Society, 2002

This
is an interactive article. Here's how it works: Have a comment or question
about this paper? Want to ask the author a question? Send your email
to the Editor
who will forward it to the author. The author then may choose to post
your comments and her/his comments on the Comments page. If you do not
want your comment posted here, please indicate so in your email, otherwise
we will assume that you have given permission for it to be posted

Reader
Questions

"On behalf
of a small group of graduate students enrolled in a nursing
research course, I’d like to ask the author about the theoretical and
conceptual framework behind her paper as well as the larger study of which
her paper was a part. We are attempting to perform critiques of
quantitative nursing research studies in order to comprehend theories,
concepts, and frameworks. We would like to ask the author to simply identify
the key concepts and any conceptual map that was developed"
--M. Randall

The Authors Respond:

"The conceptual model includes the following variables: condom use self-efficacy,
outcome expectancies related to condom use; personal HIV prevention goals;
anxiety related to condom use; drug and alcohol use; and condom use behaviors.

The conceptual model is based on social cognitive theory as proposed
by Albert Bandura (1997). According to the model, we expect that self-efficacy
will have a direct relationship to condom use and an indirect relationship
through personal goals, anxiety, and outcome expectancies. We expect
that outcome expectancies will have a direct relationship to condom use
and an indirect relationship through personal goals. Personal goals will
have a direct relationship with condom use as will anxiety and drug and
alcohol use.

Based on social cognitive theory, we expect that individuals with higher
levels of condom self-efficacy, more positive outcome expectancies, lower
anxiety about using condoms, limited or no alcohol and drug use during
sex, and stated HIV prevention goals will be more likely to report condom
use behaviors. Moreover, we anticipate that individuals with high levels
of self-efficacy will report less anxiety about using condoms, more positive
outcome expectancies related to condom use and will be more likely to
state an HIV prevention goal. Likewise individuals who report more positive
outcome expectancies related to condom use will be more likely to state
an HIV prevention goal.

We tested part of this model in a study published in Nursing Research.
The citation is:
DiIorio, C., Dudley, W.N., Soet, J., Watkins, J., Maibach, E. (2000).
A social cognitive based model for condom use among college students.
Nursing Research, 49 (4), 1-7.

At the time, we published the work, we had not completed the coding
of the goals and therefore, goals were not included in the
model."